40+ Claims Associate Interview Questions and Answers

Health is the state of being physically, mentally, and socially well. Insurance is done to protect oneself from financial loss due to unexpected health issues.

• Health refers to the overall well-being of an individual, including physical, mental, and social aspects.

• Insurance is done to mitigate the financial risk associated with unexpected health issues.

• Health insurance provides coverage for medical expenses, hospitalization, and other related costs.

• Without insurance, individua...read more

Medicare and Medicaid are both government healthcare programs in the United States, but they serve different populations and have different eligibility criteria.

• Medicare is a federal health insurance program primarily for individuals aged 65 and older, as well as certain younger individuals with disabilities.

• Medicaid is a joint federal and state program that provides health coverage to low-income individuals and families, including pregnant women, children, and people with di...read more

Copay, coinsurance, and out-of-pocket expenses are all terms used to describe the portion of medical costs that patients are responsible for paying.

• Copay is a fixed amount that patients pay for a specific medical service or prescription drug.

• Coinsurance is a percentage of the cost of a medical service that patients are responsible for paying.

• Out-of-pocket expenses are the total amount of money patients pay for medical services and prescription drugs that are not covered by in...read more

Insurance is a contract between an individual and an insurance company to protect against financial loss.

• Insurance provides financial protection against unexpected events such as accidents, illnesses, and natural disasters.

• Premiums are paid to the insurance company in exchange for coverage.

• There are different types of insurance such as health, auto, home, and life insurance.

• Insurance claims are filed when a covered event occurs and the insurance company pays out benefits.

• Insu...read more

Claims are requests made by policyholders to insurance companies for compensation for damages or losses incurred.

• Claims are requests for compensation for damages or losses

• They are made by policyholders to insurance companies

• Claims can be related to property damage, theft, accidents, or injuries

• Insurance companies investigate claims to determine their validity

• Valid claims are paid out to the policyholder

Fraud and non-claim analyst deal with detecting and preventing fraudulent activities related to claims. Debit cards are linked to bank accounts for making electronic transactions. Different types of accounts include savings, checking, and money market accounts. Chargeback is a process where a transaction is reversed. There are various types of ATM cards for different uses.

• Fraud and non-claim analysts focus on identifying and preventing fraudulent activities in insurance claim...read more

Legato is a term used in music to describe smooth and connected notes. Insurance is a contract between an individual or organization and an insurance company to provide financial protection against potential losses.

• Legato refers to playing or singing notes smoothly and without interruption.

• In insurance, individuals or organizations pay premiums to an insurance company in exchange for coverage against potential risks or losses.

• Insurance policies can cover various aspects such ...read more

Journal entry of drawings from own proprietary business

• Create a journal entry with the date of the transaction

• Debit the drawings account and credit the owner's equity account

• Include the amount of the drawings in the entry

• Example: On 1/1/2021, $500 was withdrawn from the business for personal use. Debit Drawings for $500 and credit Owner's Equity for $500

CHAMPVA is a healthcare program for eligible dependents of veterans, providing coverage for medical services and prescriptions.

• CHAMPVA stands for Civilian Health and Medical Program of the Department of Veterans Affairs.

• It is a comprehensive healthcare program for the dependents of veterans who are not eligible for TRICARE.

• CHAMPVA covers a wide range of medical services, including doctor visits, hospital stays, mental health services, and prescription medications.

• Eligible dep...read more

Void claims are claims that are invalid or incomplete, Medicare has different types, denials can be based on various reasons, and OI types refer to other insurance types.

• Void claims are claims that are missing information or are incorrect, leading to rejection by the payer.

• Types of Medicare include Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage), and Part D (prescription drug coverage).

• Types of denials can be based on eligibility, coverage...read more

Various types of steel materials are used in the make of cars, including high-strength steel, mild steel, and advanced high-strength steel.

• High-strength steel is used for structural components to improve crash safety and reduce weight.

• Mild steel is commonly used for body panels and other non-structural parts.

• Advanced high-strength steel offers a good balance of strength and formability, making it ideal for various car components.

A copay is a fixed amount that an insured person pays for a covered healthcare service at the time of receiving the service.

• Copay is a form of cost-sharing between the insurance company and the insured individual.

• It is a predetermined amount that the insured person must pay out of pocket for each visit or service.

• Copayments can vary depending on the type of service, such as doctor visits, prescription drugs, or specialist consultations.

• For example, a health insurance plan may...read more

I expect a salary increase of 10% from my current CTC.

• I have researched the market rates for Claims Associates and based on my experience and skills, I believe a 10% increase is reasonable.

• I have consistently performed well in my current role and have received positive feedback from my superiors, which justifies the salary increase.

• I am confident that my skills and expertise will contribute significantly to the company's success, making me deserving of a higher compensation.

• I...read more

Claims refer to requests made by policyholders to insurance companies for compensation for damages or losses covered by their insurance policy.

• Claims are requests made by policyholders to insurance companies for compensation for damages or losses covered by their insurance policy.

• Claims can be related to various types of insurance policies such as auto, home, health, and life insurance.

• The process of filing a claim typically involves providing documentation of the damages or ...read more

There are multiple types of claims in this process.

• There are claims related to property damage.

• There are claims related to bodily injury.

• There are claims related to liability.

• There are claims related to theft or vandalism.

• There are claims related to natural disasters.

• There are claims related to medical expenses.

• There are claims related to lost wages.

• There are claims related to death benefits.

UB04 is a standard claim form used by healthcare providers to bill for services provided to patients in a facility setting.

• UB04 is also known as the CMS-1450 form

• It is used for billing Medicare, Medicaid, and private insurance companies

• The bill type field on the form indicates the type of service being billed, such as inpatient or outpatient

• The facility type field indicates the type of healthcare facility, such as hospital or nursing home

• The POS field indicates the place of s...read more

I developed an interest in maritime law through my passion for sailing and fascination with international trade.

• Growing up near the coast sparked my curiosity about maritime activities

• Studying international business in college introduced me to the complexities of maritime law

• Interning at a maritime law firm provided hands-on experience in the field

• Attending seminars and workshops on maritime law further deepened my interest

• Reading case studies and following landmark maritime ...read more

HIPAA (Health Insurance Portability and Accountability Act) is a US law that protects the privacy and security of patients' health information.

• HIPAA is an acronym for Health Insurance Portability and Accountability Act.

• It was enacted in 1996 to establish national standards for the protection of individuals' medical records and other personal health information.

• HIPAA applies to healthcare providers, health plans, and healthcare clearinghouses that transmit health information e...read more

The URL borrower information form is a document used to collect personal and financial details of a borrower through an online link.

• The form typically includes fields for the borrower's name, contact information, employment details, income, and credit history.

• It may also request information about the borrower's assets, liabilities, and any co-borrowers or guarantors.

• The form is often used by lenders or financial institutions to assess the borrower's eligibility for a loan or ...read more

Acid test ratio is a financial metric used to measure a company's ability to pay off its short-term liabilities with its current assets.

• Also known as quick ratio

• Formula: (Current Assets - Inventory) / Current Liabilities

• A ratio of 1 or higher is considered good

• Helps assess a company's liquidity and financial health

The answer is 540.

• To solve 30% of 1800, multiply 30/100 by 1800.

• 30/100 x 1800 = 540

Sum adds all values in a range, while Sumif adds values based on a condition.

• Sum: =SUM(A1:A5) adds all values in range A1 to A5

• Sumif: =SUMIF(A1:A5,">3") adds values in range A1 to A5 where value is greater than 3

A claim is a request for payment made by an individual or organization to an insurance company or government agency.

• Claims are made when an individual or organization experiences a loss or damage that is covered by their insurance policy.

• The claimant submits documentation and evidence of the loss or damage to the insurance company or government agency.

• The insurance company or government agency reviews the claim and determines whether it is covered by the policy or program.

• If ...read more

Insurgence Principles are guidelines followed by insurance companies to manage risks and provide coverage to policyholders.

• Insurgence Principles involve assessing risks, setting premiums, and providing coverage to policyholders.

• Insurance companies use actuarial science to calculate risks and determine appropriate premiums.

• Principles include indemnity, subrogation, utmost good faith, proximate cause, and contribution.

• Insurers also follow principles of insurable interest, utmos...read more

Options are choices or alternatives that are available to a person or organization.

• Options provide flexibility and allow for decision-making.

• Examples of options include different insurance policies, investment opportunities, or career paths.

• Options can also refer to financial instruments such as stock options or futures contracts.

Insurance is a contract between an individual and an insurance company to protect against financial loss.

• Insurance provides financial protection against unexpected events

• Individuals pay premiums to an insurance company in exchange for coverage

• Insurance policies can cover a variety of risks, such as health, property, and liability

• Insurance companies use actuarial science to calculate risk and set premiums

• Claims are filed when an insured event occurs and the insurance company p...read more

Rules and responsibilities for a Claims Associate include processing claims, communicating with clients, and ensuring accuracy and compliance.

• Processing insurance claims accurately and efficiently

• Communicating with clients to gather necessary information

• Ensuring compliance with company policies and regulations

• Investigating and resolving any discrepancies or issues

• Maintaining confidentiality of client information

• Providing excellent customer service

• Adhering to deadlines and mee...read more

The truck's radiator works by cooling the engine coolant through a series of tubes and fins, dissipating heat generated by the engine.

• The radiator is filled with coolant, usually a mixture of water and antifreeze, which absorbs heat from the engine.

• As the hot coolant flows through the radiator, air passing over the fins helps to cool it down.

• The cooled coolant then circulates back to the engine to absorb more heat, maintaining the engine's operating temperature.

• The radiator a...read more

The package per annum for this position is competitive and will be discussed during the interview process.

• The package is based on experience and qualifications

• It includes salary, benefits, and bonuses

• The company offers a competitive package to attract top talent

• The exact amount will be discussed during the interview process

Mortgage insurance is a type of insurance policy that protects a lender or investor in case the borrower defaults on their mortgage payments.

• Mortgage insurance is typically required for borrowers who put down less than 20% of the home's purchase price.

• There are two types of mortgage insurance: private mortgage insurance (PMI) for conventional loans and mortgage insurance premium (MIP) for FHA loans.

• Mortgage insurance allows lenders to offer loans with lower down payments, mak...read more

The impact of Covid-19 has been widespread and significant, affecting various aspects of society and the economy.

• Healthcare systems overwhelmed with cases

• Economic downturn with job losses and business closures

• Shift to remote work and online learning

• Increased focus on hygiene and social distancing measures

• Mental health challenges due to isolation and uncertainty

I have experience handling property damage claims for auto insurance customers.

• Managed claims process from initial report to settlement

• Communicated with customers, adjusters, and repair shops

• Reviewed estimates and negotiated settlements

• Processed payments and closed claims

• Utilized insurance software to track claim status

Copay coins refers to the amount of money that an individual is required to pay out-of-pocket for a specific medical service or prescription drug.

• Copay coins are a form of cost-sharing in health insurance plans.

• They are typically a fixed amount that the insured person must pay at the time of receiving the service or medication.

• The copay coins can vary depending on the type of service or drug.

• For example, a health insurance plan may require a $20 copay for a doctor's visit and...read more

Health care refers to the organized provision of medical services to individuals or communities to maintain and improve their health.

• Health care involves the prevention, diagnosis, treatment, and management of diseases and injuries.

• It includes a wide range of services such as primary care, specialty care, hospital care, preventive care, and rehabilitation.

• Health care can be provided by various professionals including doctors, nurses, pharmacists, and allied health professiona...read more

PMI stands for Private Mortgage Insurance while MPI stands for Mortgage Protection Insurance.

• PMI is typically required for conventional loans with a down payment of less than 20% to protect the lender in case of default.

• MPI is an optional insurance that pays off your mortgage in the event of death, disability, or involuntary unemployment.

• PMI is usually paid monthly as part of your mortgage payment, while MPI is a one-time premium or added to your monthly mortgage payment.

• PMI ...read more

To replace a fender, you will need to remove the damaged fender, prepare the new fender for installation, and then install the new fender onto the vehicle.

• Remove the damaged fender by unbolting it from the vehicle

• Prepare the new fender by painting it to match the vehicle's color if necessary

• Install the new fender onto the vehicle by bolting it into place

A journal entry of provision is a record of setting aside funds for future expenses or liabilities.

• Journal entry should include a debit to the provision account and a credit to the corresponding expense account.

• Provisions are made based on estimates of future expenses, such as warranties, legal claims, or bad debts.

• Example: Debit Provision for Bad Debts $10,000, Credit Bad Debt Expense $10,000.

Copay is a fixed amount that an insured person pays for covered services, typically due at the time of service.

• Copay is a set fee that the insured individual must pay for certain services, such as doctor visits or prescription medications.

• It is typically a fixed amount, such as $20 for a doctor's visit or $10 for a prescription.

• Copays are separate from deductibles and coinsurance, and are usually due at the time of service.

• The purpose of copays is to share the cost of healthc...read more

Yes, I am comfortable working night shifts.

• I have previous experience working night shifts and have adjusted my sleep schedule accordingly.

• I am a night owl and perform well during nighttime hours.

• I understand the importance of being alert and focused during night shifts.

• I am willing to work night shifts as needed to support the team and company.

• I have reliable transportation for commuting during nighttime hours.

Claims process under motor involves filing a claim for damages or injuries resulting from a motor vehicle accident.

• Contact insurance company to report the accident

• Provide necessary documentation such as police report and photos of the damage

• Insurance adjuster assesses the damage and determines coverage

• Repair or replace the vehicle based on the insurance coverage

• Settle any medical claims for injuries sustained in the accident

I am a highly motivated and detail-oriented individual with a strong background in customer service and problem-solving.

• Customer service experience

• Strong attention to detail

• Problem-solving skills

Various types of insurance include health, auto, home, life, and travel insurance.

• Health insurance covers medical expenses

• Auto insurance covers damages to vehicles

• Home insurance covers damages to property

• Life insurance provides financial protection to beneficiaries

• Travel insurance covers trip cancellations and medical emergencies